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Flu-like symptoms improve but then return with fever and a worse cough.

New flu bug could bite work forceYou’re more likely to catch novel H1N1 virus,
but the symptoms can be milder than seasonal flu

By Dave Schafer

Although bothered by a slight cough, 2-year-old Ivy Lopez was happily on her way to day care. Then, as she was getting out of the car, she vomited.

By the time she got back home, she’d spiked a fever that would eventually hit 105 degrees. “She looked out of character. Her eyes were red and droopy, and she was lethargic,” said her mother, Jeanette Lopez, a breast-feeding peer counselor with Health & Human Services.

Ivy’s dad, Lee, called the doctor, and the next day they went in for tests. Before the results were back, Lee had the same symptoms.

The results confirmed what the Lopezes had suspected: Ivy had novel H1N1, also called the 2009 H1N1 strain, which was initially called “swine flu.”

For the next week, Lopez took care of Ivy and Lee, as well as 7-week-old Violet.

“Ivy was handling it well,” Lopez said. “It wasn’t any worse than the seasonal flu. The media has blown it out of proportion. It’s just the flu. I kept an eye on her and tried to make her comfortable.”

According to health professionals, novel H1N1 symptoms might be milder than the seasonal flu, fevers might be lower, and the symptoms might not last as long, usually about five days.

“Anytime you get the flu, it’s a problem. But for a normal, healthy person, it’s nothing to worry about,” said Dr. David Persse, EMS physician director.

In June, the World Health Organization signaled that a pandemic of novel H1N1 flu was underway.

“We’re starting to have a real big outbreak in Houston,” said Dr. Melanie Mouzoon, managing physician of Immunization Practices and Travel Medicine at Kelsey-Seybold Clinic, in early September.

Researchers are still learning about this new flu, which appeared in April. They know its symptoms are similar to seasonal flu: body aches, cough, runny or stuffy nose, fever, chills and fatigue. And some people also have diarrhea and vomiting, according to the Centers for Disease Control and Prevention.

Update

Since April, eight people have died from novel H1N1 flu in Houston, according to Health & Human Services. Seven of them died within the past five weeks.

Health & Human Services is offering novel H1N1 vaccines at nine sites. They have injectable vaccines for children 4 and up with underlining health conditions and for pregnant women. They also have the nasal spray for healthy people age 2 to 49. To get the vaccine, you’ll need to go to a site and get a number. Vaccines will be given according to the numbers. Sites open at 9 a.m., and you can arrive earlier.

According to Porfirio Villarreal, Health public information officer, the department has enough supply of each vaccine to last into the early part of next week.

The following are the sites with the vaccines:

Acres Home Multi-Service Center
6719 W. Montgomery, 77091

Airline WIC
5990 Airline Ste. 200, 77076

Braesner WIC
8632 South Braeswood, 77031

La Nueva Casa De Amigos Health Center
1809 North Main, 77009

Lyons Health Center
5602 Lyons, 77020

Magnolia Health Center
7037 Capitol, 77011

Northside Health Center
8523 Arkansas, 77093

Southwest WIC
6400 High Star, 77074

Sunnyside Multi-Service Center
4605 Wilmington, 77051

Stay home
If you get any variety of flu and are otherwise healthy, Persse said, stay home, sleep or curl up with a book, drink lots of fluids and take over-the-counter fever-reducing medicines. Isolate yourself from others and cover your coughs and sneezes so you don’t spread the disease, experts say.

For the Lopezes, isolation was easy. Nobody wanted to be around them while they were sick.

“We were treated like lepers,” Lopez said.

Doctors can only prescribe Tamiflu, which has to be started within two days of the symptoms and will only shave about one day of misery off the illness, Persse said.

However, some doctors might be hesitant to prescribe Tamiflu to otherwise healthy patients because there is a limited supply that needs to be conserved for those high-risk patients who need it according to CDC guidance.

People in high-risk categories should call their doctors right away if they start feeling sick.

Those include pregnant women, children under 2, and people with chronic illnesses, such as diabetes, asthma and heart disease, Mouzoon said. Also, people whose symptoms continue to worsen should call their doctor. (See Head to the doc’s office box.)

While Ivy and Lee got the flu, Lopez and baby Violet did not, perhaps because Violet had Jeannette’s antibodies through breastfeeding.

But that only some of those exposed to the infected got it appears to be a rarity.

Genetic shift
The flu is a contagious respiratory illness caused by the influenza virus. It’s spread when people with the virus cough or sneeze in the direction of others or into their hands and then don’t wash them.

Influenza came in three types: Influenza A H1N1, and its variant, H3N2; Influenza B; and Influenza C. Influenza A H1N1 is not the newer novel H1N1, although they have the same surface proteins.

Influenza A H1N1 is the “seasonal flu” that humans catch each year and that changes slightly as it goes around the world. Persse calls that “genetic drift.” Usually, the new mutation is close enough to the previous year’s that people who get it one year can fight it off or get a milder case the next year. However, he cautions, yearly vaccination is still the best protection against the seasonal flu virus.

But novel H1N1, which formed when human flu, avian flu and pig flu mixed in a pig and then transferred to humans, is a “genetic shift,” Persse says. Because it’s a flu most of us haven’t had before, most people don’t have the antibodies to fight it.

The result: A White House report estimates 30 percent to 50 percent of Americans may get novel H1N1 flu. When more people get it, more people die from it and more people miss work. And that could have serious economic consequences.

Since spring, the city has been working on policies, procedures and responses to widespread absences, said Candy Clarke Aldridge, acting Human Resources director. Administrative Procedure 2-8, adopted June 19, was developed in conjunction with the city’s continuity of operations plans and instructs departments to prepare for extensive absences of any kind for any reason. The city’s concern is to follow public-health experts’ advice and keep employees who come to work from catching whatever’s going around. You can view AP 2-8 at www.houstontx.gov/adminpolicies/2-8.pdf. To see the city’s 96-page pandemic flu plan, visit www.houstontx.gov/health/Emergency/pandemicplan.pdf.

But, there’s one segment of the population that doesn’t have as much to fear, early studies show.

Age matters
More than 90 percent of the approximately 36,000 people who die from the seasonal flu each year, and about 60 percent of hospitalizations, occur in people 65 or older, the CDC reports.

Ready for anything

The Health & Human Services Department bought new equipment and technology over the summer in preparation for a novel H1N1 outbreak, Troisi said. The department has set up a Web site, www.houstonh1n1.org, with the latest novel H1N1 information.

However, early studies show people age 65 and older aren’t as susceptible to the novel H1N1 virus as are those who are younger. The theory is those people were exposed to a similar virus in the past and still carry the antibodies to fight it off.

But that’s only a theory, and Persse cautions that it could simply be that older people aren’t around children as much and haven’t been exposed to it. About one in 13 novel H1N1 flu-related deaths have been children, and more than 80 percent of those were school-age children, the CDC reports.

As of early October, 60 U.S. children had died from the virus, according to the CDC. Two-thirds of them had epilepsy, cerebral palsy or other neurodevelopmental conditions.

After four days, Ivy Lopez’s fever broke. She went back to school without symptoms 11 days after getting sick.

The CDC warns that people who get the flu need to remain isolated for at least 24 hours after the fever goes down without medicine. The problem is the days before people know they have the illness.

Good hygiene
Novel H1N1 seems to have a longer incubation period, up to five days, Persse said.
“So you could be spreading it without knowing it,” he said. “That’s why it’s important to be aware of your hygiene practices – sneeze into your sleeve if there are no tissues, wash your hands after coughing into them. Throw your used tissues in the trash.”

Take heed of those, “Cover your cough” signs that sprung up in the spring in city buildings. Wash your hands and use hand sanitizer to wash away the germs. Also, don’t rub your eyes with your hands.

If a family member gets novel H1N1, you can still go to work, the CDC said. Monitor your health and practice good hygiene habits so you don’t spread it.

Yet, despite our precautions, the virus will spread.

“The epidemic could really take off and expand rapidly,” Mouzoon warns.

A vaccine
The first batch of novel H1N1 vaccine arrived Oct. 5, and information about it is changing weekly. But as of this issue going to print, the CDC said people 11 and older can prevent the misery and worry of getting novel H1N1 with a single vaccine treatment, either a shot or nose spray. Children 10 and under will need two shots.

The full effects of the inoculation won’t kick in until 10 days after the shot. For seasonal flu, it takes 14 days for full protection.

Only about 40 percent of the population gets a seasonal flu shot, said Dr. Kathy Troisi, assistant director, communicable disease control in Health & Human Services.

“People don’t think the flu is a serious disease,” she said. “But it is. Even if you don’t die from it, you’re laid low for weeks.”

Some people don’t get the vaccine because they think it was either ineffective previously or gave them the flu. “That’s not possible,” Persse said.

Flu vaccine shots for both seasonal and novel H1N1 don’t contain a live virus, Troisi said. It has dead parts of the covering of the virus, and that can’t make a person sick. The nasal spray doses contain a live virus that has adapted to living in the relative cold of your nose and won’t survive in the warmth of the throat and lungs.

If a person gets sick after getting a shot, they were already carrying the virus, picked it up before the vaccination took full effect, or have some other illness that they label “flu,” experts said.

Mouzoon said some people might have an allergic reaction to the shot that will give them a sore throat and runny eyes. And there’s the pain of a sore arm.

Little Ivy Lopez won’t have to worry about getting a vaccine for novel H1N1. She had to tough it out, as will others who get the virus before getting vaccinated. But that means she’s protected from the virus – at least until it undergoes a genetic drift.

But she will still be susceptible to seasonal flu.

“There’s no cross protection from the vaccines or from the strains of flu,” Persse said.
That could make for a long flu season. Stock up on good books and tissues.